Bone geometry, strength, and muscle size in runners with a history of stress fracture.

PURPOSE: Our primary aim was to explore differences in estimates of tibial bone strength, in female runners with and without a history of stress fractures. Our secondary aim was to explore differences in bone geometry, volumetric density, and muscle size that may explain bone strength outcomes. METHODS: A total of 39 competitive distance runners aged 18-35 yr, with (SFX, n = 19) or without (NSFX, n = 20) a history of stress fracture were recruited for this cross-sectional study. Peripheral quantitative computed tomography (XCT 3000; Orthometrix, White Plains, NY) was used to assess volumetric bone mineral density (vBMD, mg x mm(-3)), bone area (ToA, mm(2)), and estimated compressive bone strength (bone strength index (BSI) = ToA x total volumetric density (ToD(2))) at the distal tibia (4%). Total (ToA, mm(2)) and cortical (CoA, mm(2)) bone area, cortical vBMD, and estimated bending strength (strength-strain index (SSIp), mm(3)) were measured at the 15%, 25%, 33%, 45%, 50%, and 66% sites. Muscle cross-sectional area (MCSA) was measured at the 50% and 66% sites. RESULTS: Participants in the SFX group had significantly smaller (7%-8%) CoA at the 45%, 50%, and 66% sites (P

Swimmer's Shoulder.

In brief Shoulder pain caused by impingement of subacromial tissues is a common overuse injury in swimming, especially among adolescents who may have rigorous training schedules and be skeletally immature. A case of a 14-year-old girl with swimmer's shoulder demonstrates the diagnostic work-up, which involves pertinent history, inspection, palpation, and assessment of strength, impingement, and instability. Treatment focuses on icing, relative rest, physical therapy, and modifying the swimming workout to reduce overuse and impingement.

Detecting Graves' Disease.

In brief Graves' disease has a multitude of presentations, and certain symptoms can mimic sports-related concerns such as overtraining. A review of three cases of Graves' disease in young athletes illustrates the spectrum of symptoms and the pathophysiology. Diagnosis involves a detailed patient history, physical exam, and appropriate lab studies, including a thyroid radioactive iodine uptake scan. Treatment consists of symptom management and antithyroid medication, radioactive iodine thyroid ablation, or, rarely, thyroidectomy.